Psychometric Properties and Clinical Utility of the Boston Cognitive Assessment (BOCA) on an Acute Rehabilitation Unit

Abstract

Objectives

To elucidate the psychometric properties of the Boston Cognitive Assessment (BOCA) in a sample of inpatients in an Acute Rehabilitation Unit (ARU). To introduce the clinical utility of the BOCA, a digital cognitive screen on an ARU.

Design

Retrospective cross-sectional design.

Setting

Acute Rehabilitation Unit at a free-standing, 138-bed inpatient medical rehabilitation hospital.

Participants

Hospital records from 32 patients were identified wherein individuals completed the BOCA and Montreal Cognitive Assessment (MoCA). Admission diagnoses included neurological and nonneurological injuries.

Interventions

The BOCA and MoCA test administration were 10 and 15 minutes, respectively. BOCA Total Score and individual subtest scores were examined, along with demographic and clinical variables. Exploratory factor analysis, internal consistency, concurrent validity, and known-group validity were examined.

Main Outcome Measures

The BOCA is a computerized, self-administered measure of global cognition (Gold et al., 2021; Vyshedskiy et al., 2022) and evaluates immediate recall, delayed recall, language reasoning, visuospatial reasoning, executive functioning, attention, mental math, and orientation. The MoCA is a paper-and-pencil screening instrument for cognition (Nasreddine, 2005) and evaluates wordlist recall, visuospatial and executive functions, language, attention, and orientation. For both measures, the maximum score is 30; lower scores reflect greater cognitive difficulties.

Results

Average age was 59.13 years (SD, 16.49y; range, 25-85y). Average years of education was 14.9 years (SD, 3.46y). Average BOCA total score was 25.13 (SD, 4.46) and average MoCA total score was 23.44 (SD, 4.59). Similar to studies of outpatients, the BOCA demonstrated a unitary factor structure accounting for a plurality of the variance, adequate internal consistency (a=0.73), and strong concurrent validity with the MoCA (r=0.57; P=.003). This study explored differences in BOCA performance among those admitted with primary brain injuries compared with those admitted for nonneurologic conditions. Those admitted to the ARU with brain injuries scored significantly lower than those admitted for nonneurological etiologies (U=67.50, P=.025).

Conclusions

There is increasing need to access novel and efficient cognitive screening tools within an inpatient rehabilitation setting. This study provides initial evidence that the BOCA maintains similar factor structure, reliability, and validity in inpatient samples compared with what has been observed in outpatient samples. These findings provide preliminary support for deploying the BOCA in inpatient settings. The BOCA is a useful screening instrument for assessing cognition in neurologic patients within an ARU, with ease of administration, short administration time, and clinically useful data to aid clinical decision making. Clinical utility of the BOCA, limitations, and directions for future research are discussed.

Disclosures

none.